Hindawi
International Journal of Hypertension
Volume 2018, Article ID 2815193, 7 pages
https://doi.org/10.1155/2018/2815193
Research Article
Sociodemographic Characteristics, Dietary Practices,
and Nutritional Status of Adults with Hypertension in
a Semi-Rural Community in the Eastern Region of Ghana
Esi K. Colecraft ,1 Matilda Asante,2 Aaron K. Christian ,3 and Seth Adu-Afarwuah1
1Department of Nutrition and Food Science, University of Ghana, P.O. Box LG 134, Legon, Accra, Ghana
2Department of Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana,
Accra, Ghana
3Regional Institute for Population Studies, University of Ghana, Legon, Ghana
Correspondence should be addressed to Esi K. Colecraft; colecraft s@hotmail.com
Received 22 February 2018; Revised 12 May 2018; Accepted 31 May 2018; Published 18 July 2018
Academic Editor: Tomohiro Katsuya
Copyright © 2018 Esi K. Colecraft et al.This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction. Hypertension is a major contributor to the global disease burden and mortality. Evidence suggests increasing
hypertension prevalence in Ghana but there is limited public awareness and information on the characteristics of those with the
disease. Objective. To describe the baseline characteristics of adults with hypertension who were randomized to receive either
hypertension related nutrition education plus hospital-based standard of care or only the standard of care (control group) in
Asesewa, a semi-rural community in the Eastern Region of Ghana. Only baseline data were used in the present analysis.Methods.
A cross-sectional baseline survey was completed for 63 adults with confirmed hypertension diagnosis. Data on sociodemographic
characteristics and diet were obtained through interviews and participants’ body mass index (BMI) was computed. Pearson chi-
square statistic was used to assess differences between those with both elevated diastolic blood pressure (DBP) and systolic blood
pressure (SBP) and those with only elevated SBP. Results. Mean ± SD age of participants was 54.5±13.8 years. Approximately 71%
of participants had both elevated SBP (>140 mmHg) and DBP (>90 mmHg) while the remaining 29% had only elevated SBP. The
median number of times the food groups beneficial to hypertension management were consumed in the preceding week to the
interview was 1 for green leafy vegetables, 1 for dairy products, 2 for fruits, and 4 for legumes. The median number of times for
consuming harmful food groups was 3 for salted fish and 7 times for fats and oils. Signifcantly more participants in the age group
above 50 than the younger participants had elevated SBP (83.3 vs. 16.7:P=0.027) and those with BMI equal to or greater than 25
were more likely to have both elevated SBP and DBP (P=0.047). Conclusions. Findings from this study have implications for the
prevention and management of hypertension in this semi-rural population.
1. Introduction 1980 and 2008, the opposite occurred in most African coun-
tries. With an estimated hypertension prevalence of nearly
The decision to render the phrase “Control your blood 37% in 2008, the African region had the highest prevalence
pressure” as the theme for 2013 World Health Day signified of EBP. InGhana, early reports suggested hypertension preva-
increasing recognition that elevated blood pressure (EBP) or lence of less than 10% and less than 20% in rural and urban
hypertension is an important global public health concern populations, respectively [3]. However, a 2010 systematic
[1]. Similarly, noncommunicable diseases were highlighted in review revealed that, between 1970 and 2007, hypertension
the 2012WorldHealth Statistics report inwhich hypertension prevalence was between 19% and 48% [4].Whilemost studies
was estimated to contribute to more than one-half of the generally reported lower hypertension prevalence for rural
deaths from stroke and about 45% of deaths from heart compared to urban localities, an assessment of hypertension
disease [2]. The report also showed that while hypertension prevalence in four rural communities in the GaDistrict of the
prevalence declined inmost industrialized countries between Greater Accra Region reported rates of 25% and 37% among
2 International Journal of Hypertension
traders and farmers, respectively, leading to the authors’ Asesewa has a youthful population (50.9%) representing a
conclusion that hypertension is not only an urban concern broad-based pyramid with an elderly population of about
in Ghana. Most Ghanaians with EBP in past studies were 6%. Most people in the area (73.0%) are employed in the
unaware that they had the condition [5]. agricultural sector [14].
Despite the increasing burden of hypertension in Ghana,
there is limited context specific information on the sociode- 2.2. StudyDesign andParticipants. Thiswas a cross-sectional,
mographic and lifestyle risk factors of those affected. Identi- baseline study of adults enrolled in theDASH-based nutrition
fying such risk factors is important for intervention planning, education intervention study between February and July
especially in a low resource contextwhere lifestyle related pre- 2015. Potential participants were adults (>25 years old) who
ventive actions may be important in averting progression of responded to announcements at places such as the main
mildly hypertensive or prehypertensive individuals to a more market, selected local churches, and the Asesewa Govern-
serious disease state requiring costly medical intervention. ment Hospital at Asesewa for free blood pressure screening
Hypertension related deaths in low- and middle-income as well as adults attending outpatient services at the Asesewa
settings could potentially be reduced substantially by apply- Hospital, who had elevated BP.
ing lessons learnt in high-income countries. One diet-based Those screened with elevated blood pressure (systolic
intervention that has been efficacious in reducing blood blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood
pressure among thosewith hypertension aswell as preventing pressure (DBP) ≥ 90 mmHg) and those with EBP who were
hypertension is theDietaryApproaches to StopHypertension identified from the hospital OPD were asked to complete
(DASH) diet pattern developed in the United States and two consecutive follow-up measurements at the Asesewa
successfully adapted elsewhere including South Africa [6, 7]. Government Hospital to confirm the diagnosis. Persons with
The DASH diet promotes a dietary pattern that supplies a confirmed diagnosis who agreed and signed the informed
nutrients shown to be “beneficial” (specifically, potassium, consent document after the study procedures had been
magnesium, and calcium) in the prevention andmanagement explained to them were recruited into the study. Ethical
of hypertension while minimizing “less beneficial” or “poten- approval for the studywas granted by the Institutional Review
tially harmful” nutrients (e.g., sodium and saturated fat and Board of theUniversity ofGhanaNoguchiMemorial Institute
cholesterol) with respect to their effects on blood pressure for Medical Research. All participants signed or thumb-
[8]. The DASH dietary pattern emphasizes reducing sodium printed (if illiterate) a written informed document before
(salt) intake, increased consumption of fruits, vegetables, and being recruited.
low-fat dairy products and moderate consumption of whole
grains, nuts, fish, and poultry.TheDASH diet is based on evi- 2.3. Study Procedures. Blood pressure (BP) screening was
dence indicating that an increase in the consumption of fruits done by trained project personnel using the digital Omron
and vegetables has consistently been shown to be associated Blood PressureMonitors (HEM-759-E, Omron Corporation,
with lowering risk of hypertension [9]. Recommendations Kyoto, Japan), while the BP measurements to confirm hyper-
concerning reducing the consumption of meat and poultry tension diagnosis were completed by the nursing staff at the
are also consistent with the increasing number of studies Asesewa Hospital. At enrolment, a pretested questionnaire
indicating that their increased intake increases hypertension was used to collect information on background sociode-
risk [10]. Epidemiological studies on the relationship between mographic characteristics, personal and family history of
the consumption of whole grains and hypertension are far chronic diseases, and history of alcohol consumption and
from being consistent. While some studies have found a cigarette smoking. A 7-day food frequency questionnaire
lower risk of coronary heart disease others do not [11, 12]. (FFQ) was used to obtain information about the number
Reduction in salt intake is strongly recommended as one of of times different food groups were consumed in the past 7
the top priority actions to tackle noncommunicable diseases days. The FFQ was based on foods typically consumed in the
and reduction of deaths from hypertension [13]. locality and grouped in such a way to enable assessment of
In 2015, a randomized controlled trial to test the impact whether study participants’ intake is in accordance with the
of a nutrition education intervention based on the DASH DASH dietary pattern. Salted fish was added as a separate
diet principles on blood pressure was implemented among food group because it is a regular ingredient in Ghanaian
adults with blood pressure in Asesewa, a semi-rural township cuisine which contributes significantly to salt intake with
in the Eastern Region of Ghana. Baseline data collection on potential implications for hypertension. Additionally, partic-
the study population (to facilitate pre- and postintervention ipants’ weights were taken to the nearest one kilogram with
comparisons of outcomes of interest) permitted the current an Omron Body Composition Analyzer and Scale (Omron
analysis, which was aimed at describing the sociodemo- Healthcare, Inc., VernonHills, IL, USA). Participants’ heights
graphic characteristics, dietary habits, and nutritional status were taken with a Stadiometer to the nearest 0.1 centimetre.
of adults with hypertension enrolled in the nutrition educa- Anthropometric measurements were taken in duplicate and
tion intervention study. the averages computed.
2. Methods 2.4. Data Analysis. We performed statistical analysis by
using Stata package 12 (STATA Corporation, Texas, USA).
2.1. Study Area. The survey was carried out in Asesewa in the Body mass index (BMI) was computed from weight and
UpperManya KroboDistrict in the Eastern Region of Ghana. height measurements and participants were categorized as
International Journal of Hypertension 3
underweight (BMI: < 18.5), normal weight (BMI: 18.5–24.9), Table 1: Selected background sociodemographic characteristics of
overweight (BMI: 25.0–29.9), and obese (BMI: > 30.0). study respondents.
Descriptive statistics, mean ± SD for continuous variables
and frequencies (%) for categorical variables, were used to Characteristic n=63
summarize the data. The data on consumption of different Sex
food groups in the past week were skewed with some of Female 55.6 (35)
the food groups having outliers; therefore median values Male 44.4 (28)
were also computed. Bivariate analyses using Pearson Chi- Age in years 54.5 ± 13.8
Square Statistic were used to assess whether there were signif- Ethnicity
icant differences in sociodemographic characteristics, dietary Krobo 76.2 (48)
intakes, and nutritional status between study participants Other 23.8 (15)
with both elevated SBP and DBP and those with isolated only Religious affiliation
SBP. Christianity 90.5 (57)
Islam and traditional religion 9.5 (6)
3. Results Marital status
Sample. A total of 1165 adults were screened for hypertension Married / Cohabiting 55.6 (35)
and about 24% (n=282) had elevated systolic blood pressure. Single 44.4 (28)
Only sixty-three adults with confirmed elevated systolic and Education
diastolic blood pressure completed the baseline survey. Of No education 22.2 (14)
these approximately 29% (16) had systolic hypertension only, Primary 17.5 (11)
while the remainder had both elevated systolic and diastolic Junior High 38.1 (24)
blood pressure. Mean ± SD systolic and diastolic blood Senior high/Technical and Vocational 4.8 (3)
pressure of study participants were 151.9 ± 7.4 and 92.5 ± 7.7,
respectively. Tertiary and above 17.4 (11)
Employment status
Sociodemographic Characteristics of Respondents. About 56% Unemployed 3.2 (2)
of the respondents were female, with a mean ± SD age Farming and fisher folks 17.5 (11)
of 54.5±13.8 years (Table 1). The majority were of Krobo Traders 38.1 (24)
ethnicity (76.2%) and Christian faith (90.5%). Approximately Salaried workers 22.2 (14)
one-fifth of respondents did not have any formal educa- Artisans and labourers and others 19.0 (12)
tion and only 17% had the tertiary level education. At the Household size 5.1 ± 2.6
time of the survey, only a few (3.2%) of the participants Households income
were unemployed. The most common occupation was petty
trading (38.1%) and about 22% of respondents had salaried ≤ 200 GH 61.9 (39)
occupations. Approximately 56% of the participants were >200–600 25.4 (16)
married or lived with a partner (cohabiting). The mean >600 12.7 (8)
household size was 5.1 (SD 2) persons. Values represent percentage (number) or mean ± standard deviation.
Reported monthly household income was less than 200
Ghana Cedis (1 Ghana Cedi is approximately 0.23 US dollars)
for the majority of participants and only 13% of households The median frequencies of consumption of legumes, green
had incomes higher than 600 Ghana Cedis per month. leafy vegetables, and fruits were 4, 1, and 2, respectively, in
the past week.
3.1. Nutritional Status of the Study Respondents and Family Fish and seafood were the most consumed animal source
History of Chronic Conditions. The mean ± SD BMI of the of foods. Salted fish and fats/oils were consumed a median of
respondents was 27.1 ± 5.3 with 38.1% and 25.4% of the 3 and 7 times, respectively, in the past week.
respondents being overweight and obese, respectively. About
one-fifth of study participants reported having at least one 3.3. Comparison of Sociodemographic Characteristics, Family
familymember being overweight or obese. A family history of History of Chronic Disease, and Nutritional Status between
hypertension (55%)was themost common followed by stroke Participants with Both High Systolic and Diastolic BP and
(23.8%). About 16% of the respondents reported a family Those with Only Isolated Systolic BP. Summary of compar-
history of diabetes and 8% had relatives that have suffered a isons of sociodemographic factors, family history of chronic
heart attack. diseases, and nutritional status between participants with
both elevated SBD and DBP and those with only isolated
3.2. Dietary Intakes of Respondents in the Preceding Week. elevated SBP using Pearson Chi-Square Statistic is shown in
Non-green leafy vegetables, roots and tubers, and cereals Table 2. A significantly greater proportion of respondents
were themost frequently consumed foods by the respondents who were below 50 years had both elevated systolic and
in the past week (Figure 1). The median frequencies of diastolic blood pressure (46.7% versus 16.7%; p=0.027) and
consumption of these foods were 16, 12, and 9, respectively. a greater proportion of obese/overweight individuals had
4 International Journal of Hypertension
Table 2: Comparison of sociodemographic, anthropometric, and family health characteristics between participants with both elevated SBP1
and DBP2 and those with only elevated SBP.
Hypertension Classification
Characteristic Both elevated SBP and Isolated elevated SBP P-Value3
DBP (n=45) (n=18)
Age in years 0.027
26–49 46.7 (21) 16.7 (3)
50–95 53.3 (24) 83.3 (15)
Education 0.502
No formal 20.0 (9) 27.8 (5)
Some formal education 80.0 (13) 72.2 (13)
Family history of at least one chronic
disease 0.935
No 37.8 (17) 38.9 (7)
Yes 62.2 (28) 61.1 (11)
BMI 0.047
Normal (18.5–24.9) 28.9 (13) 55.6 (10)
Overweight/obese (≥25) 71.1 (32) 44.4 (8)
Values represent% (n). 1Elevated systolic blood pressure ( 140 mmHg); 2≥ elevated diastolic blood pressure (≥ 90mmHg); 3Pearson Chi-Square Statistic.
(SAGE), Lloyd-Sherlock et al. reported that compared to five
(5) other low- and middle-income countries the Ghanaian
sample had the lowest prevalence of hypertension awareness
of just 23.3% compared to a range of about 38% for India
and South Africa to 72.1% for Russian Federation [16].
The increasing hypertension prevalence [4] and the serious
consequences of the diseases warrant that attention be given
to public education efforts as a primary prevention measure
to address this growing public health problem.
In this study, the age of the respondents was found to be
significantly associated with either having both elevated sys-
tolic and diastolic blood pressure or having isolated elevated
Figure 1: Respondents’ median frequency of consuming foods from systolic blood pressure. Older adults (50 years and above) had
different food groups in the past seven days. elevated isolated systolic consistent with other findings; older
respondents had elevated isolated systolic blood pressure.
This was consistent with similar studies in rural and urban
both elevated systolic and diastolic pressure compared to India [17]. Contrarily to our expectation a greater proportion
individuals within the normal body size (71.1% versus 44.4 of respondents below 50 years had both elevated systolic
%; p=0.047) (Table 2). and diastolic high blood pressure compared to their older
Other sociodemographic factors such as family history counterparts. There is, however, an increase in the incidence
of hypertension, income, and dietary intakes showed no of young adults with hypertension in other populace [18].
significant difference among the various categories. These findings also buttress the need for the increased
call for routine checks for high blood pressure among young
4. Discussion adults as advocated for older adults. This is because, notably,
young adults with elevated systolic and diastolic pressure are
This study contributes to our current knowledge of the char- likely to have a slower rate of receiving an initial diagnosis
acteristics and potential predictors of hypertension among than middle-aged and older adults in their study [19]. This
adults living in semi-rural communities in Ghana. It is can easily lead to a various health complication.
important to note that less than 50% of those screened Also, more than half (55%) of the respondents in this
with elevated BP returned for the necessary confirmatory study reported that they had a family history of hypertension.
tests to determine their hypertension status. This apathy to This is much higher than the 35.7 % reported in a study on
follow-up on screening results may reflect lack of awareness the frequency of hypertension and prehypertension among
about hypertension and its consequences which have been adults in Hohoe, a municipality in the Volta region of Ghana
noted among socioeconomically disadvantaged individuals [20]. A review of population-based studies on hyperten-
and communities [15]. Using data from the World Health sion in Ghana indicated that hypertension was positively
Organizations’ Study on Global Aging and Adult Health associated with a positive family history of hypertension
International Journal of Hypertension 5
[21]. However, a study in Saudi Arabia, which examined the salted fish consumption was about 3 times in the past week
risk factors for diabetes and hypertension among expatriate and while the present study did not show a significant rela-
workers, revealed that family history was not significantly tionship between salted fish consumption and having either
associated with hypertension [22]. both elevated SBP andDBP or isolated SBP, this link has been
The predominant occupation of the respondents in this established in other studies. For example, among Japanese
study was trading. This is likely to predispose them to men, systolic blood pressure was significantly higher in the
hypertension due to the job-related stress and inappropriate higher quintiles of salt intake while in India total dietary
food consumption andmeal patterns. Concerning the level of salt intake was a significant risk factor for hypertension
income of the respondents, themajority of themwere earning even after controlling for potential confounders [34, 35].
GHS200.00 or less. This low-income level may influence Conversely, significant reduction in dietary sodium intake
the dietary habits of the respondents and their ability to has been identified as an effective way of lowering SBP in
purchase foods beneficial for hypertension prevention and Asian patients [36, 37]. Thus, measures to reduce salt intake
control [23, 24]. However, the systematic review by Addo may contribute to effective hypertension management in the
and colleagues on hypertension in Ghana showed an incon- study population.
clusive relationship between income level and hypertension Food groups such as legumes and green leafy vegetables
[5]. that have potential benefits for hypertension management
Our study found significant differences in nutritional [38, 39] were minimally consumed by respondents in the
status (BMI) between participants with both elevated systolic week preceding the survey. Despite the benefits of legume
and diastolic blood pressure and those with isolated SBP. consumption to hypertension management, results from this
The association between BMI and blood pressure is well study corroborate others from even developed countries
established with several studies reporting higher likelihood such as the United States reporting only about 8% adults
of elevated BP among overweight and obese individuals consuming legumes on any given day [40].
[25–27]. A study assessing the determinants of isolated The intake of dairy foods, which are good sources of
systolic hypertension in North India among both urban and calcium and potassium, was very low among the study par-
rural areas showed that BMI was a significant independent ticipants. A systematic review and meta-analysis of elevated
predictor of isolated systolic hypertension [17]. In our study blood pressure and consumption of dairy foods showed
a significantly higher proportion of participants with both that consumption of low-fat dairy foods was associated
elevated SBP andDBPwere overweight or obese compared to with a 13% reduction in risk of high blood pressure [41].
those with only isolated SBP. Similarly, a study conducted in However, although the DASH diet recommends foods high
South Korea found that having BMI ≥23 was associated with in calcium, a study in rural African community did not
uncontrolled hypertension among elderly people [28]. Zhang find an association between the frequencies of consum-
and colleagues in their research among rural Chinese women ing dairy products and the prevalence of hypertension
also reported that although obese women had an increased [30].
risk of hypertension, “BMI was more related to isolated The findings of this study provide useful information on
diastolic hypertension than to isolated systolic hypertension” dietary habits of people with hypertension in a low-income
[29]. rural community which may inform hypertension manage-
The frequency of consuming food from various food ment services.The study also points to the need for education
groups was also found to be a contributory factor to and awareness among the general populace to foster better
having either an isolated elevated SBP or both elevated health-seeking behaviours for hypertension screening and
SBP and DBP. This research found out that respondents management. Furthermore, lessons from this study will assist
consumed fewer green leafy vegetables and fruits, which in developing programs for healthy ageing consistent with the
generally tend to be higher in potassium needed in the World Health Organizations global strategy on ageing and
management of hypertension and had increased intake of health [2].
fats and oils. A cross-sectional study on the prevalence
and correlates of hypertension among rural populations in
Sub-Saharan African revealed that frequent intake of fruit Data Availability
and vegetables was associated with lower blood pressure Data will be made available when requested.
measures [30]. Additionally, a research in Chile showed
that increased intakes of fruits and vegetables reduced the
systolic blood pressure [31]. Some studies have identified Conflicts of Interest
lower income levels as a contributory factor to lower intake of
fruits and vegetables and higher consumption of fatty foods The authors declare that they have no conflicts of interest.
[23, 32].
Generally, although the restriction of salted foods is Acknowledgments
considered an appropriate strategy for the control of high
blood pressure adherence to this recommendation is often The study was partly funded by the University of Ghana
a challenge [33]. In the present study, the consumption of Research Fund. The authors appreciate the contributions of
salted fish and fats and oils was higher than recommended for HumphreyThompson, Janet Carboo, and Claudia Ewa to the
individuals with hypertension. It was observed that median execution of this study and publication.
6 International Journal of Hypertension
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